Project Summary: This developmental research is framed within the global effort to reduce maternal-newborn mortality in low resource settings. Specifically, the approach of this proposal is to conduct a community-based participatory research study in which (lay) community health workers (CHWs) and maternity health providers (nurses and nurse-midwives) join together to question, collect data, analyze, and disseminate why women in the Dominican Republic with obstetric complications delay accessing healthcare critical for survival. The specific aims of the research are to: 1) To orient and train a Dominican community-based team in community based participatory research (CBPR) in which team members consist of two different constituencies that share the common interest of improving the quality of obstetric care: lay CHWs represents one constituency, maternity healthcare personnel from the public hospital that serves the neighborhoods where the CHWs reside represents the other constituency. 2) To identify the relevant cultural knowledge, attitudes, beliefs and behaviors of pregnant and parous women, as well as the male family members who have experienced maternal loss, that affect how women access and participate in publicly funded obstetrical care. 3) To compare the differences between the interpretations of qualitative data analyzed by CHWs from the interpretations of qualitative data derived by maternity healthcare personnel to build upon knowledge of the community's role in data analysis in CBPR. The proposal addresses a problem of high national and international significance among a very vulnerable population. Conceptually, the midwifery model of care is integrated into the approach of using CBPR for quality care improvement. The scientific area of CBPR will be advanced by the comparative analysis of the interpretation of data by CHWs and health providers and the value of having both constituencies} hear} each other. Also, building research capacity among health providers is more likely to provide utilization of findings and sustained participation after the research funding is completed. Finally, if the process of using the conceptual framework of the midwifery model to design and conduct CBPR is successful, this process has potential transferability to many other vulnerable low resource settings, in the US and internationally. PUBLIC HEALTH RELEVANCE: The proposal addresses a problem of high national and international significance among a very vulnerable population. Conceptually, the midwifery model of care is integrated into a project of community-based participatory research (CBPR) for quality care improvement. Specifically, the approach of this proposal is to conduct a community-based participatory research study in which a community of two constituencies, (lay) community health workers (CHWs) and maternity health providers (nurses and nurse-midwives), join together to question, collect data, analyze, and disseminate why women in the Dominican Republic with obstetric complications delay accessing healthcare critical for survival.